Receiving medical services via telehealth was a requirement for some during the pandemic but has continued to grow in popularity since then.

In states such as Nebraska with large rural areas, telehealth can be especially important. Certain pandemic-era telehealth "flexibilities" allowed by the Centers for Medicare and Medicaid will expire at the end of this year, prompting a new report by the Bipartisan Policy Center.

The report, "Positioning Healthcare Policy to Ensure High-Quality, Cost-Effective Care," recommended Congress make some of the changes permanent or at least extend them.

Maya Sandalow, senior policy analyst at the center, stressed the need for more research on telehealth. She called existing research "promising" but said it shows the quality can really vary.

"By what a person is seeking telehealth for, what service a provider is offering, and also what type of telehealth a provided," Sandalow outlined. "Is it a video where the patient and provider can see each other, or is it a visit over the telephone?"

The report supported allowing patients to continue to choose the location for their telehealth visits and allowing behavioral health services via telehealth without an in-person visit first, assuming the provider has a plan for patients in a crisis. Nebraska law has required both from Medicaid and state-regulated insurance companies since 2021, and payment parity -- paying the same rate for telehealth as for an in-person visit -- since 2023. However, only the Centers for Medicare and Medicaid Services can establish the guidelines for Medicare.

Sandalow acknowledged some believe payment parity is crucial to maintain access to services, whereas others fear it may "incentivize" providers to offer only telehealth services. But she stressed there is no doubt telehealth increases access to care, especially when it comes to behavioral and mental health services.

"It can be really high quality, equally good as compared to in-person care," Sandalow contended. "We're living in a behavioral health crisis, and any measures to expand access to care are really important."

Jed Hansen, executive director of the Nebraska Rural Health Association, said in addition to improving access, some find telehealth a more comfortable way to receive mental health services, especially in smaller communities.

"It just helps create that additional privacy by being able to stay in your own home or even close the door in your office and take that meeting," Hansen explained. "As opposed to having to drive and park your vehicle in front of a mental-health place."

Sandalow emphasized the need for the Centers for Medicare and Medicaid Services to find a way to assess the quality and costs of fully virtual providers and telehealth companies in particular.

On a related note, Hansen stressed the need to ensure telehealth regulation does not make it easier for out-of-state providers to interfere with the ability of Nebraskans to maintain a relationship with their local provider.

"What we don't want to have happen are these sweeping telehealth bills, and then to have an Amazon or a Walmart, or someone on the West Coast, that may not be providing an apples-to-apples service, and they'll come in and undercut the local health care system," Hansen cautioned.

A diagnosis of diabetes increases the risk of heart disease, stroke, kidney disease and even death.

The School of Public Health at Indiana University-Indianapolis is close to completing a project to improve the health of three neighborhoods. The Diabetes Impact Project works in the Northeast, near Northwest, and Near West neighborhoods in Indianapolis, where rates of diabetes are almost double other parts of Marion County.

Lisa Staten, associate professor of community and global health at the university, said the project's three-tier approach involves community health workers assisting people with diabetes in managing their diet and glucose monitoring, while also addressing their social needs.

"The community health workers work with them to understand, is there a food security issue? Are there challenges with housing?" Staten explained. "We also have neighborhood community health workers that are located in these three parts of the city, to help raise awareness about diabetes prevention and diabetes risk."

The third tier, which Staten described as the most direct, is made up of steering committees, funding projects to improve physical activity infrastructure and healthy food access, address mental health concerns and build social connections. According to the Indiana Department of Health, about 12% of Hoosiers are diabetic.

The $12 million eight-year program is a partnership with the Fairbanks School of Public Health, Eli Lilly and Company, Eskenazi Health and the Marion County Health Department. One component was to have a federally qualified health center located in each of the areas for more community-based involvement.

Staten pointed out diverse neighborhood input was sought prior to the project's funding.

"We approached community residents and asked what they wanted to see in it," Staten recounted. "They said they don't want a one-year project. 'We don't want you to come in and take our data and go. It needs to be a long-term commitment.' And we listened to that and incorporated all that into it."

Despite the pandemic, which happened during the project, Staten added the researchers were able to continue their work. The findings will be published in academic journals and public forums for the community to see its impact.


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A North Carolina woman is speaking out about the importance of the Affordable Care Act and the Inflation Reduction Act.

DonnaMarie Woodson, who battled cancer during the 2008 recession when her husband lost his job, credits the Affordable Care Act for providing vital health insurance for her family. Enrolling in the federal program allowed Woodson to undergo regular screenings, leading to the early detection of colon and breast cancer.

Now, Woodson is urging lawmakers to protect important health care programs.

"The Affordable Care Act literally saved my life," Woodson asserted. "Because I would not have gone to get screened because of medical debt."

She pointed out the Inflation Reduction Act has also had a profound effect on her family, particularly in managing her husband's Type 1 diabetes. She said the measure's insulin cap helped reduce the cost of his medicine from $200 to $35. It has made a significant difference for their fixed income household.

According to Tufts University, the Affordable Care Act has been challenged in court more than 2,000 times. The Inflation Reduction Act has also met its
fair share of pushback and votes to repeal different provisions in the law.

Woodson argued if the programs are not protected, it could pose severe risks to people across the country.

"People's lives are at stake. People will die," Woodson stressed. "That is a plain fact without health care, quality affordable care, not just in your care but quality affordable care. People need that and it's a right."

Today, Woodson's story extends beyond her personal experiences. She actively works with the American Cancer Society Cancer Action Network to lobby for health care rights, emphasizing the necessity of maintaining and expanding health care programs. She encouraged others to share their own experiences in their communities and make their voices heard by local leaders.


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In rural Tennessee, many residents lack access to healthy, fresh, and affordable food. So, two health center systems in the state are sprouting solutions - with community garden programs.

Aura Sheran - a certified clinical medical assistant with East Tennessee State University's Johnson City Community Health Center - said the garden connects patients, the community, and volunteers - which fosters a collaborative effort to address food insecurity and promote healthier choices.

"We serve a lot of the community, that don't have enough funds to purchase produce and that kind of thing, food wise," said Sheran. "So, it helps them to cut some of that cost back, and to take some produce home and share with their family."

Community health centers serve more than 423,000 patients across Tennessee, regardless of their insurance status or ability to pay.

Nicole Vanover is a phlebotomist with Ballad Health who provides lab services to the ETSU clinic.

She said community partners - like the Appalachian Resource Conservation and Development Council, which runs a food access program - help to provide resources, and vendors provide funding and equipment.

"Tractor Supply - both the Johnson City Tractor Supply and the Jonesborough Tractor Supply store - each donated about $150 to $200 worth of products," said Vanover. "That was soil, fertilizer, tomato cages, things like that."

She added that the garden flourishes with the support of volunteer ETSU students who help maintain it, and clear the beds at the end of each growing season.

Cherokee Health Systems maintains legacy gardens at its Alcoa, Maynardville, and New Tazewell health centers.

Ginny Weatherstone, community development consultant with Cherokee, said the gardens serve as community spaces where patients can interact.

And they honor the memory of former CEO - Dr. Dennis Freeman, who had a passion for gardening from his Iowa farm upbringing.

"Growing things was something that he did growing up, and it was always near and dear to his heart," said Weatherstone. "He got sidetracked there, leading a rather large organization for over 40 years, and always in the back of his mind had the idea of community gardens that would serve our patients."

Weatherstone pointed out that participants also learn about gardening in Cherokee Health Systems' psychiatric day-treatment program.

So, the garden serves a dual purpose - providing fresh fruits and vegetables for patients, and helping people with mental illness learn how to cope.

"We really do believe that these gardens are an important part of the day treatment program. They are scheduled now into the the daily activity, the list of things that are going to be done," said Weatherstone. "There is nothing like a bowl of fresh strawberries to just really make somebody feel good about what they've been able to accomplish."




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